What is Feline Diabetes?

Diabetes. What it is, what it's not, and understanding the difference.

Written by Michele (a nurse) and Esse, FDMB members

So, you just got the news from the vet. Your fuzzy darling has diabetes! Insulin shots, blood testing, sugar values, infections. Life as you know it is ruined.

Is it?

No, not really. There are a lot of things to learn about diabetes, some new things to stick into the daily grind, but honestly, you'll be just fine.

Understanding diabetes is the best place to start. What it is, what it's not, what's happening in the body, and how to control it are just the first bits of info you'll need. With a good understanding, you'll find that you'll be on top of the situation in no time.

Sugar. What we put into our coffee, eat in sweet things, drink in sodas.sugar. It's everywhere. And it's important.

The body needs a certain amount of sugar to produce enough energy to keep on living. Imagine a cell as a small globe, with 'doorways' leading into and out of it. That's the basic structure of the body.a cell. From the blood, certain things like salt and sugar and protein find their special 'doorway', enter the cell, and feed the cell what it needs to do it's job - make another cell, or make a hormone, or make energy, or all of that and more. Some cells have many jobs, some cells have only one or two; but all are important to the body's health.

Specifically to sugar, the cell's doorway has a lock on it. Insulin, a hormone, has the key. I call insulin a "key" because if a sugar molecule and an insulin molecule hold hands, insulin can open the cell door, let the sugar in, and then close the door behind it; but without insulin, there is no key to opening the door. The sugar can knock on the door all day long, and nothing happens; the cell can't open the door and let the sugar in by itself.

But the cell needs the sugar. To make energy, or to make a new cell wall, or to create a protein, the cell can't do it's job without sugar. Each and every living cell needs sugar - especially the brain cells - and if there isn't any available, things in the system start to go wonky. The body can't produce energy, and without energy, the body can't do it's normal things like keep blood flowing, let signals from nerves get to the places it is supposed to go, and, in the end, breathing and thinking get affected and sometimes stopped. Not so good, right?

Insulin is the key to the door. If there is no insulin, the sugar can't make it into the cells. If the cells don't have sugar, they can't function. Pretty simple.

So where does sugar come from? Mostly from the foods we eat. There's sugar that we eat - sweetened stuff (like coffee and tea), sugar from proteins (like meat and legumes), and sugar from carbohydrates (like breads, potatoes, cereals, rice, pasta). Cats need far fewer carbohydrates than humans do, so when we give them carbohydrates, it shows up as sugar that they can't use. Cats don't actually drink sweetened drinks, or eat ice cream (well ... so one of mine actually likes ice cream, but whatever). Their bodies are designed to extract enough sugar for their cells' needs from protein, and not from sweetened stuff or from carbohydrates (for more info on that, look at Dr. Peirson's article on feline diet).

When there is too much sugar in the system, other organs have to work harder to clear the sugar. The liver, kidneys, and circulatory system go into high gear, and do their best to get the extra sugar out of the body. The liver takes it and hides it away for future use. Once that happens, and there's still extra sugar, the kidneys stick it into urine, and the sugar passes out of the body through peeing. But after a while, sometimes the liver's storage is full, and the kidneys can't get more sugar into the urine, and the blood system has to hold onto the sugar until something changes. And that's when we get "high" blood sugar numbers.

Well, what about insulin? Where does it come from? It comes from the pancreas. The pancreas is a floppy bit of tissue that lays over the top of the stomach and next to the liver. There are special cells called "beta cells" which only produce the hormone insulin; that's their whole job. They do nothing else, really, except make insulin. When the body discovers that the cells don't have enough sugar, insulin runs out of the pancreas, chases down a sugar molecule, and escorts it into the cell that needs it to make whatever it is the cell makes - thoughts, nerve conduction, energy for movement or building new cells.whatever that cell's job is.

So, why isn't there enough insulin? Because the beta cells are damaged somehow. Sometimes, it's temporary. Sometimes, it's permanent. It can be from a virus, infections, trauma, some medications (steroids), or even just because we've worn them out with too much sugar or carbohydrate consumption. But whatever causes it, the beta cells are not working anymore; which means they can't send out insulin to escort the sugar into the cell; which then means that the cell can't do it's job. That's called diabetes.

What we see at that point is high sugar numbers in the blood stream. The meters count only that sugar which can't be brought into the cells, usually because of a lack of insulin. We'll also see things like lots of peeing and lots of water drinking, lots of hunger, weight loss, hair loss, skin changes.all because there is no sugar available to let those cells do their jobs. (More about that in a minute.)

When we put insulin into the body, we are replacing the hormone our body naturally makes. This replacement takes the sugar from the blood stream and into the cells, and lets the cells use it for their work. When you have enough of the hormone insulin and the right balance of sugar, urination will become normal, eating will become less frenzied, hair growth will resume, and energy will be restored. Why? Because all the cells are getting what they need, and are able to do their job again.

All because of a little hormone called insulin.

But too much insulin is actually far more dangerous than too little. Imagine all these insulin molecules standing by the door to the cell, waiting for sugar to cross it's path, lurking, lying in wait.as a sugar molecule comes by, the insulin will kidnap it, throw it into the cell, and slam the door (I call that the "Insulin Gestapo").well, once that goes on for a little while, there is not enough sugar for the rest of the cells, right? That's why we treat low sugar by putting sugar back into the system - so we can use up the insulin 'Gestapo' and let the cells who need it, get it, and do their job. That's the whole idea behind feeding the low sugar event; we're using up the excess insulin, and trying to create a balance of available sugar and enough insulin so the sugar can get into the cell, but not an overactive insulin molecule that kidnaps sugar and throws it into the first available cell it finds.

So finding the balance - the correct ratio of sugar to insulin - is important. The only real way to do that is to test the blood a lot, and see how much sugar is left in the blood, and at what time it's there. We can reduce or increase the insulin based on that information, and make it better for the cells to have a continuous, regular supply of sugar to do it's job. But it's vital to know how much sugar is in the blood stream at a given point, because you don't want to create the Insulin Gestapo. The only way to know that, is to test. And test. And test.

Diabetes is a pretty simple illness to understand. But it's important to really understand it, because the key is the balance between sugar and hormone insulin. That's the "sugar dance", as we call it.the in and out of sugar and insulin in the cells, the replacing of insulin that the body can't make for whatever reason, and finding the correct amount of insulin to give so that there is enough sugar in the blood, but not too much and not too little. And, much to our dismay, it can vary from day to day, and even time to time within a day, depending on food, stress, happiness, and - let's face it, they're cats; they do their own thing.

So why all the peeing? The excessive thirstiness? The rough hair, the dandruff? The weight loss?

Peeing too much comes from the kidneys realizing "hey, there's a lot of sugar here. We'll filter some out and throw it into the urine, and get rid of it that way." The kidneys go to work and creates a lot of urine production in a short amount of time, and it has to let it go down to the bladder and out. Voila, lots of peeing.

Well, why the thirst? Because when the body is getting rid of sugar, it takes water from the rest of the body to make the urine, to give the sugar somewhere to go, and the end result is peeing. The body realizes that the kidneys are using a lot of water up, more than usual, and says "hey, we need more water!" and triggers the thirst response. So drinking goes way up, because the body's pee production is in overdrive, and the body needs to have enough water in it for everything else. So now you've got big time thirst, too.

Peeing and drinking. Fine. So what about the eating like they're starving?

If the body's cells think they're not getting sugar, even though it's in the blood stream (remember the doorway and the key?), the body says "hey, get some food in here so we can break it down to sugar and get the sugar into the cells for energy. We're starving here!!" Problem is, it's not actually a lack of food; rather, it's a lack of insulin keys to get the sugar into the cells.but the cells don't know that. They just figure that if more food comes, they'll be able to get the sugar they need. Wrong message, but it's what happens. The body is trying to stay alive, the cells are trying to do their job; but without sugar (because the door is locked, and insulin is the key), they can't. So they trigger the hunger response.and more food is consumed.

Which, of course, raises the blood sugar even higher. Which, in turn, makes the liver store a lot of sugar, and then the kidneys work overtime to get rid of the excess sugar in the blood stream, which, of course, leads to more peeing, which then in turn leads to more drinking.

Vicious cycle, isn't it?

So, why is there weight loss?

Because if the body can't use the materials sent to it through food, it will turn to its pantry. The pantry is all the stored 'fat' the body has; it's been stored for exactly times like this - starvation times. The cells raid the pantry, but if the pantry can't be restocked (because there is no insulin to provide the key), the body uses up all it's stored stuff, and then starts breaking itself down so it has enough food to keep the vital functions going - the brain, the heart, and the lungs. The weight loss comes from raiding the pantry.and even though we put food into the body - it can't use it, because there is no insulin to unlock the doorway and let the sugar in from all that food that's been eaten.

If the body can't get enough food and sugar from the stored fat, it will turn to the muscles. If you imagine this process as if it were a house and there is a bad snowstorm outside, it helps. Let's say this storm has been raging for a while now. You've eaten everything in the fridge, and burned all the wood in the woodshed. Now, you're cold, and hungry. You start getting into the pantry, and soon deplete all of that. You've burned the chairs and dining table for heat. And the storm is still raging - no let up in sight. Now what are you going to do? Start taking down the cabinets and using that for firewood.and then the built in bookshelves. And then the walls. That's sort of what the body is doing by breaking down the muscles; using the structures of the house (body) as a source of energy to keep the vital systems going.

After all the fat has been depleted, the body turns to the muscles as sources of food. The body will canabalize itself, again to preserve the vital functions, and break down the protein that the muscles are made from. This is a problem, you know? What happens is that the cell takes what it needs from these broken muscles, and lets the rest remain in the blood stream. When that stuff gets to the kidneys, the kidneys again are in overdrive, trying to get rid of this stuff - called ketones - and throws it out in the urine. Ketones are the end products of excess protein - or leftover muscle - and are a result of having no insulin in the blood to let the sugar go into the cells. The body breaks down the muscles (the cabinets and walls of the "house"), and the by-product is called ketones.

The biggest issue with ketones is that they clog up the kidney's tubes and collecting spots. It's like hair in a drain - a little isn't so bad an issue, but collect a lot and you've got yourself one good, solid clogged up drain. So if ketones are clogging the drain, the stuff the kidneys are supposed to send out of the body - sugars, excess protein bits, and lots of toxins - stay in the blood, and soon, the kidneys give up; they can't work under those conditions, and just kind of throw up their hands and go on strike. If that happens, it's called "acute kidney failure", and it's pretty serious.

With insulin, though, the cells get the sugar they need because insulin provides the key to the sugar doorway. The cells don't have to resort to breaking down the muscles; they don't have to find other sources of sugar to produce energy. They don't get to starvation mode, and they don't get dehydrated because the kidneys are using up all the water available in the body. Everything works the way it's supposed to, and no backup systems get triggered. Cells thrive, produce energy needed for everything, and all is in balance (called "homeostasis").

We do need to replace the insulin, as that is the foundation for everything here. If there is one hormone more important than any other one, it's insulin. But it's a dangerous hormone, too. If you put insulin into the body, there is always a chance to produce the dreaded "Insulin Gestapo" and have a low sugar event (called 'hypoglycemia'). But again, the way to deal with that is to use up the Gestapo - give them all the sugar they can handle, and get them all tired out and broken down.

Use the insulin carefully. "Start low, go slow" is the motto around here. Don't start giving a lot of insulin in the beginning, because you don't really know how much sugar your baby has available. When you increase, increase slowly; prevent the Insulin Gestapo from arriving by carefully testing, monitoring, and handling a low sugar count quickly. And especially don't give high doses of insulin if you're changing the diet to a high protein, ultra-low carb one. That might be all your feline "owner" needs - a change of diet. But you won't know unless you're testing regularly, right? Change the dose after you've changed the diet, but not at the same time. Otherwise, how will you know which had the effect you wanted?

And before you get overwhelmed about the testing and the injections, realize this: it's totally doable. It's a learned skill, and you will have some ups and downs, but you and your fuzzy friend can learn it together. There are a lot of tutorials available, and there are many people here who will help walk you through it. You can do this!

That's what diabetes is, in a nutshell. It's a common, survivable, chronic issue for both people and felines. The good news is that in felines, sometimes those beta cells come back from vacation, heal, and get back to work! That doesn't happen in humans... lucky cats, right?